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Exercise beats angioplasty for some heart patients

heart_30.08.09

Exercise beats angioplasty for some heart patients

Working up a sweat may be even better than angioplasty for some heart patients, experts say.

Studies have shown heart patients benefit from exercise, and some have even shown it works better than surgical procedures. At a meeting of the European Society of Cardiology on Sunday, several experts said doctors should focus more on persuading their patients to exercise rather than simply doing angioplasties.

Angioplasty is the top treatment for people having a heart attack or hospitalized with worsening symptoms. It involves using a tiny balloon to flatten a blockage and propping the heart artery open with a mesh tube called a stent. Most angioplasties are done on a nonemergency basis, to relieve chest pain caused by clogged arteries cutting off the heart’s blood supply.

“It’s difficult to convince people to exercise instead of having an angioplasty, but it works,” said Rainer Hambrecht of Klinikum Links der Weser in Bremen, Germany.

Hambrecht published a study in 2004 that found that nearly 90 percent of heart patients who rode bikes regularly were free of heart problems one year after they started their exercise regimen. Among patients who had an angioplasty instead, only 70 percent were problem-free after a year.

Hambrecht is now conducting a similar trial, which he expects to confirm his initial findings: that for some heart patients, exercise is more effective than a surgical procedure.

Other experts agreed that would likely be the case.

An angioplasty “only opens up one vessel blockage,” said Dr. Christopher Cannon, an associate professor of medicine at Harvard University and spokesman for the American College of Cardiology. He was not linked to Hambrecht’s research. “Exercise does a lot more than fixing one little problem.”

Among other benefits, exercise lowers bad cholesterol while raising good cholesterol, helps the body process sugar better, improves the lining of the blood vessels and gets rid of waste material faster. Exercise also lowers blood pressure and prevents plaque buildup in the arteries.

Previous research has estimated one third of heart disease and stroke could be prevented if patients did two-and-a-half hours of brisk walking every week. In the U.S., that would mean 280,000 fewer heart-related deaths every year.

Joep Perk, a professor of health sciences at Sweden’s Kalmar University and spokesman for the European Society of Cardiology, said two thirds of heart patients in line for an angioplasty could probably get better benefits by regularly working up a sweat.

Experts say less than 20 percent of heart patients get the recommended amount of exercise — about 30 minutes of moderate activity five times a week.

Perk said doctors who performed angioplasties on their patients without asking them to change their lifestyles were ignoring the fundamental problem. “It would be like getting rid of the most troubled rust spots on a car without doing anything to stop more rust from appearing tomorrow.”

Still, doctors admitted that persuading patients to exercise instead of simply going in for an angioplasty, which can take less than a day, would be a tough sell.

“Most patients want the quick fix,” Cannon said. Exercise may improve patients’ hearts better than an angioplasty, but it may also take months or even longer for patients to feel the benefits. “It’s a lot easier to get your artery fixed than it is to exercise every day.”

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Diabetes drug kept breast tumors away in mice

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Diabetes drug kept breast tumors away in mice

Adding the common diabetes drug metformin to chemotherapy helped shrink breast cancer tumors faster in mice and keep them away longer than chemotherapy alone, raising hope for a more effective way to treat cancer, U.S. researchers said on Monday.

They said metformin appeared to target breast cancer stem cells — a kind of master cancer cell that resists conventional treatment and may be the source of many tumors that grow back.

“What’s exciting here is we now have something that is mechanistically a different kind of killer of cancer that can synergize with chemotherapy,” Kevin Struhl of Harvard Medical School, whose study appears in the journal Cancer Research, said in a telephone briefing.

Many teams have been looking for ways to destroy the master cancer cells in the hope of making cancer easier to cure.

Last month, a team at the Broad Institute of Harvard and the Massachusetts Institute of Technology reported that a chemical called salinomycin could kill breast cancer stem cells.

What is different with his study, Struhl said, is that metformin is a widely used drug with a long safety track record. “There are tens of millions of people who take this drug,” he said.

“Although our studies are limited to mice and cells, metformin has a history of anti-cancer effects,” he said.

Metformin has already been shown to reduce the risk of some cancers, including pancreatic and breast cancer, in large studies of people with diabetes.

Struhl said metformin’s affect on cancer stem cells appeared to be separate from its ability to help the body use insulin and lower blood sugar — which also can improve breast cancer survival.

His team studied metformin and the cancer drug doxorubicin in lab dishes and found they killed both human cancer stem cells and non-stem cancer cells.

Mice that had tumors and got metformin and chemotherapy were less likely to have tumors grow back two months after treatment compared with mice that got chemotherapy alone.

“When we had both drugs together, we lost the tumors faster, but more importantly, there was no relapse,” Struhl said.

He said with metformin, it may be possible to reduce the chemotherapy dose and still get the same benefit.

That will need to be studied in people and a study is getting under way. Dr. Jennifer Ligibel, at Dana-Farber Cancer Institute and Harvard, is organizing a large trial with colleagues in Canada to study metformin in women with early stage breast cancer.

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Only 10 percent of U.S. adults have low heart risk

in.reuters.com

Only 10 percent of U.S. adults have low heart risk

Ninety percent of American adults have at least one risk factor for heart disease, researchers reported on Monday.

Virtually all Americans either have high blood pressure, high cholesterol, high blood sugar, are overweight, smoke or exercise too little, the team led by the Centers for Disease Control and Prevention reported.

“Unfortunately, the limited strides that were made toward this goal during the 1970s and 1980s were eroded by the increases in excess weight, diabetes and hypertension during more recent decades,” the CDC’s Dr. Earl Ford, who led the study, said in a statement.

Ford’s team looked at four national studies covering tens of thousands of Americans aged 25 to 74.

Only 10 percent had low risk scores in all five categories, they reported in the journal Circulation.

“Until the early 90s, we were moving in a positive direction, but then it took a turn and we’re headed in a negative direction,” said Ford.

“When you look at the individual factors, tobacco use is still headed in the right direction and so are cholesterol levels, although that has leveled off. The problem is that blood pressure, BMI (body mass index, a measure of obesity) and diabetes are all headed in the wrong direction.”

Heart disease is the No. 1 killer in the United States and many other countries.

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